Frequently-Asked Questions (FAQ) about Pre-Certification and Prior Authorization
of Certain Prescription Drugs

What is "Pre-Certification"?
Simply put, "pre-certification" is the process of a member or provider contacting Preferred Care to make sure that a health care service or a visit to a health care provider will be covered by the member's plan before the services performed or the visit takes place.

What is "Prior Authorization"?
"Prior authorization" is a type of pre-certification, possibly involving a clinical review of these requests.

Why are Pre-Certification and Prior Authorization Important?
The processes of prior authorization and pre-certification assure that medically necessary, cost effective therapies have been considered for you by your doctor(s) and that patients meet certain clinical criteria for the service or procedure that the doctor is recommending.

What is the"New Drug Prior Authorization Program"?
The New Drug Prior Authorization Program extends the period of time that new drugs must be monitored for safety before they can be offered in the marketplace. You may still obtain the new drug if you have had adverse effects or failed treatment with conventional therapies.

Last updated: December 20, 2006